Tuesday, May 20, 2014

Using the Giant Medicare Physician Data Database

In April 2014, after years of legal efforts by multiple parties, including the Wall Street Journal, CMS released nearly 2 GB and some 10 million lines of physician data.   Both the Wall Street Journal and New York Times provide simple consumer friendly websites where you can look up a single doctor by name and zip code and see his Medicare billings for calendar year 2012.

Although it took most of a day, I was able to use the database for some client projects and I've made a Powerpoint deck and online 20 minute video that explains how the database(s) can be used. Details after the break.

For NPR's story on the data release, click here.
For many other news stories, Google... Medicare releases physician data April 2014 .
For investigative stories at ProPublica, click here and for its data search box, here.
For an investigation of California office visits in the data, here.
For a DarkDaily report on pathologist data, here.

For a CMS-authored NEJM article, appearing 5/29/2014, here.
For a counterpoint NEJM viewpoint, also 5/29/2014, here.

For the Medicare agency press release, here.
For the AMA press release, here.

For an adverse article by Dr. Penson of Vanderbilt, here.  (Blog discusses Penson, here.)

For the CMS homepage for all the data files, click here.

To see the PowerPoint on which I made a 20 minute video, click here.
Note:  You can read the PPT online, or if you click a small "down arrow" in the upper left, you can download it also.

To see a rough draft 20 minute video course I recorded, and loaded to YouTube, click here.

Why would you want to do this?   If you were negotiating with a Medicare contractor about their policy on a topic, and didn't think it was applied well, YOU have access to all the utilization of that CPT code in THEIR jurisdiction in 2012.   You could ask, "Why do you let some doctors bill this 50 or 100 times per patient?  Who would possibly need it more than 10 times?"   Or you could say, service X is used appropriately in your jurisdiction, used only by X doctors for Y patients and never more than twice per patient.   

If you want to see all the utilization of any given injectable drug, represented by a "J" supply code, presto, it's right there in these public spreadsheets.   If you take the utilization for a service per state, and manually add a column of data for the Medicare patients in each state, you can get utilization per 1000 beneficiaries by state.  Or per 1000 physicians sorted by state.   

If you are visiting the "Maryville Laboratory" in Pennsylvania on a sales call, you can see every test they billed Medicare in 2012.   "We see you used Test X over 10,500 times a year, and we at SupplyCo would like your business to sell you the kit for that."   

Finally, if you don't care about the PowerPoint or the video course, you can find a short nerdy verbal explanation of my key learnings in working with the database using only basic Excel skills, here.

A May 23, 2014 article in JAMA on Medicare's payments for treating macular degeneration opened with a sentence about the CMS database, and payments to ophthalmologists receiving over $1M from CMS...although the rest of the article did not refer again to the database.  Here.  This is interesting rhetoric - the database -- which was new and in the media and in the buzz-o-sphere - seemed to be the foundation of the article, but wasn't.